More thoughtful analysis of the American EMR experience courtesy of the website.

It is becoming apparent that more and more EMR users are finding themselves trapped with an EMR that they either did not want, or that they signed up for only because of fire sale prices enabled by government subsidization.

Hmmmm… sounds familiar…

The result is that customer satisfaction is in freefall.

Yet more evidence that the New Brunswick approach of “my way or the highway” is wrong.

Dead wrong.

Read on to find out why, and how we could do things differently here:

I Despise My EHR, But I’m Still Using It


The Holy Grail…


As the New Brunswick EMR dream of “One Patient, One Record” continues to unravel and costs skyrocket there is growing recognition outside of the realm of the New Brunswick Medical Society that the key to successful and meaningful use of electronic medical records lies in getting disparate systems to talk to each other. It is abundantly clear that we need a variety of EMR software packages to fit a variety of physician needs, and that these products need to be able to exchange data with a minimum of fuss and bother.

Achieving this might be akin to finding the Holy Grail, at least according to a recent article by Dr. Eric Cadesky of Vancouver, published in the June 2015 edition of “Future Practice.” The analogy fits to a degree, but a better analogy might be finding the Rosetta Stone, the original “interoperability engine.”

You can read the full article here: Interoperability: The Holy Grail of EMR’s

The message is clear, and there is a rising tide of voices opposed to the suppression of information sharing as exemplified by the curiously named Data Sharing Agreement between the New Brunswick government and the New Brunswick Medical Society.

Time to step back and rethink the plan. Blindly pursuing a model which relies on a single EMR vendor runs counter to what is best for patients and the medical community. We need interoperability, and the sooner the better. If we are to make any progress toward that goal, we need buy-in on the part of the NBMS and the New Brunswick government.

Sadly, we have neither.

The future is now…


Yesterday was a great day for the dozens of Telus EMR users in New Brunswick and for their estimated 100,000 plus patients.   The most recent software upgrade has some innovative advances in functionality and convenience but, most importantly, Telus clients now can have instant, continually updated access to their EMR data anywhere, anytime.

It’s all done by simply downloading an app which allows the user’s phone to be linked to the office EMR.  With the new software, Telus clients can access their patient data, office schedule, and contact information in seconds via a secure, password-protected encrypted portal.

As far as I know, no other vendor in the province has anything like this, which is a shame, because it is definitely going to make doctors’ lives a whole lot easier.   And it is only the beginning.

Thinking about buying an EMR system?   As the saying goes “Choose Wisely.”  It’s a major investment of time and money, and you want to go with a company that can deliver the goods.

If you are interested in what Telus has to offer, this is a good starting point:

And here is a link to the App Store:

Think this is the final piece of the EMR puzzle that you needed to take the plunge?  Still not convinced?  Why not get a demo of the software.  You won’t be disappointed!

Now, I’ve been saving the best for last.

Other EMR vendors have been known to jealously guard and protect their turf from competitors.  One even signed a secret deal with the government preventing doctors form accessing their patients’ medical information!

Telus is actively promoting and developing technology which allows different EMR systems to talk to each other, making efficient, straightforward exchange of information a reality.  In the EMR business, it’s known as interoperability.    It’s more than just a buzzword.  It’s the way of the future.

Running free…


“And then one day you find ten years have got behind you.  No one told you when to run.  You missed the starting gun.”  Pink Floyd – “Time”

As New Brunswick continues to buck the worldwide trend for interoperability between health care information systems it seems appropriate to pause for a moment and consider how long this battle has been going on, and give credit to the early adopters of electronic medical records for recognizing the importance of various electronic systems being able to talk to each other.  Not only were early adopters first out of the blocks with new technology, in most cases they paid their own way, recognizing that improved handling of patient records would have important benefits for the their practice, and for the patients for whom they provide services.

Interoperability is the key to the establishment of a healthy EMR industry in New Brunswick.

Flash back to 2004, and this insightful report from the American College of Physicians:

Data Sharing

In 2014, everywhere there is progress dismantling information silos in favour of the free exchange of health care information.

Everywhere but here.

The New Brunswick provincial EMR program is stuck in a rut, jealously guarding access to information in order to further the monopolistic ambitions of a single vendor.  The proponents of the plan boast of the dozens of doctors who are said to have started to use their EMR product.   They have been able to achieve a modicum of success in a variety of ways:   1) handing out taxpayer money to offset their clients’ cost, and 2) forging a secret deal with the Department of Health, in order to cripple the competition.

Does that make for fair competition?

I think not!

Even I could run a faster 100 metres than Usain Bolt, if his ankles were shackled.





I Hate Blockers…


Don’t get me wrong.   I like Dan Blocker.  He was my favourite character on the 1960’s TV show Bonanza.   Perhaps I have some sort of connection with big, lumbering, generally good-natured hicks who occasionally blow a gasket.  Can’t imagine why.   I also like beta blockers.   They are great for keeping the blood pressure down, and they prevent heart attacks.   Even Blue Blockers, the darling of the 1990’s infomercial sunglasses set, have their place, just not on my face.

But information blockers…. that’s another story.   In the EMR world, this term refers to I.T. companies that deliberately set out to inhibit the free exchange of information between medical professionals.    In New Brunswick, this practice is well illustrated by the egregious Data Sharing Agreement, which prevents me from getting proper access to my patients’ lab data.

If there was ever any doubt that the blocking of free exchange of health information was a bad idea, read on.  This is a huge issue in the United States, and the Senate appears to be on the verge of taking drastic action to penalize EMR vendors who seek to prevent information exchange.

From the June 2014 Draft Report from the Committee of Appropirations
United States Senate:

Information Blocking.—The Committee urges ONC [Office of the National Coordinantor for Health Information Technology] to use its certification program judiciously in order to ensure certified electronic health record technology [CEHRT] provides value to eligible hospitals, eligible providers and taxpayers. The Committee believes ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use. The Committee requests a detailed report from ONC regarding the extent of the information blocking problem, including an estimate on the number of vendors or eligible hospitals or providers who block information. This detailed report should also include a comprehensive strategy on how to address the information blocking issue.

The Data Sharing Agreement forged between the New Brunswick Medical Society and the Province of New Brunswick is a prime example of information blocking. If the U.S. Senate has it’s way, EMR companies like Velante and Intrahealth – were they to be conducting business in the U.S. – would be decertified.

It has come to this in the United States because things were done wrong in the first place.   EMR vendors were permitted to build isolated information silos which precluded the sharing of information.   Now they have a terrible mess which is going to be very expensive to fix.

In New Brunswick, the adoption of EMR technology lags behind both the United States and the rest of Canada.   Perhaps our Medical Society could learn from the mistakes of the past, and take steps to break down the barriers to information exchange.

The first step would be to abolish the Data Sharing Agreement.

How about it?

Zen and the art of home electrical maintenance…


Last evening around 8:30, I performed my first useful act of the day.   I replaced a faulty dimmer switch in our kitchen.   How did I manage to get through an entire day without doing anything productive or useful?   Easy.   I attended the Annual General Meeting of the New Brunswick Medical Society.

At the meeting, some educational sessions were held, some speeches and reports were given, and a succession of doctors made motherhood statements about how the Society needs to be united and how we need to ensure that the NBMS serves the needs of all doctors.

All well and good.   No argument here.

The problem occurred when attention was turned to the topic of electronic medical records.   We heard some interesting statistics about how many doctors are using the Provincial EMR system offered by Velante, and some questionable (only because they have been wrong so many times before) projections about future conscripts to the system.   And we heard about how things are looking good for Velante now that the taxpayers are kicking in $1.5 million dollars a year to support the program.

Good for them.   I am happy that the subsidized program is doing what they wanted it to do.

It’s a different picture entirely for doctors who use one of the competing EMR packages.    These doctors, numbering well over 100 across the province, have been actively denied electronic access to their patients’ medical data.   This unfortunate state of affairs came about when, on June 13, 2013, the NBMS and the Province of New Brunswick signed a document entitled “Data Sharing Agreement.”    This document contains within it a provision that only one EMR vendor – the one marketed by Velante – will be permitted to interconnect with Department of Health databases.

This provision, his along with hefty government subsidies to Velante clients, creates a very uneven playing field for the other vendors.   It is, at its heart, an anti-competitive document.

Velante is ballyhooed as a “doctor-controlled” company, even though only two of the seven members of its board of directors are MDs.   So how well, as an offshoot of the NBMS, does it manage to hold to the principle of serving ALL NB doctors?

Answer:  it doesn’t.

Velante serves only its clients and the I.T. company Accreon, which owns 49 percent of Velante.  Early adopter of EMR technology and people who have recently chosen other EMR systems which better fit their needs are marginalized and their legitimate concerns are ignored.   The only time the NBMS is willing to give them the time of day, is when they are trying to lure them into switching vendors, as they dangle the bait of wads of taxpayer money.

You may think “But wouldn’t it be better if all NB doctors used the same EMR?”   This might appear to be an attractive option at first glance but there are a few problems with this concept.  Lets’s start with the three obvious ones.

First of all, not all NB doctors need the kind of EMR Velante is offering.    It is a “bells and whistles” system which is much more complex and expensive than many doctors need.    Second, the establishment of a single vendor and a province wide monopoly is bad for the consumer.   I have commented extensively on the reasons for this and will not repeat the rationale here.   Suffice it to say, when has a monopoly ever been good for the consumer? Thirdly, and most importantly, New Brunswick does not exist in a bubble.    Even if we were to have every doctor in the province using the same EMR, what happens when patients leave the province, or immigrate from other parts of Canada, or other countries?  Are their healthy records portable?  How do we manage the transfer of electronic data?

The solution is interoperability.

In order to have an optimally functional EMR system on a national and international basis, we need to ensure that data can be readily exchanged between different, competing EMR products.  This is where we are headed, and this is the essence of interoperability.   Numerous technology experts have commented that interoperability is the future, and we need to encourage and welcome it.   Patient health information is not owned by the EMR vendors and it is immoral and very likely illegal to refuse to permit the migration of data from one EMR product to another.   In other words, the days of the “walled silos” of isolated, patient information are coming to an end.    The EMR vendors know that that this is coming, and the forward-thinking ones are preparing for the end of proprietary, selfishly guarded databases.

Yet in New Brunswick, the NBMS and the Department of Health have colluded to prevent non-Velante users from having equal access to their patients’ data.

New Brunswickers need to recognize this.   The NBMS, in particular, needs a better vision for the future.   A corporate monopoly is short sighted.  We need a provincial EMR system which is inclusive and welcomes diversity and personal choice.

The naysayers have said “Oh, it’s so complicated to transfer information from one system to another.   It will never happen.   It’s too hard.”    While I agree, it may be difficult and expensive at this time to move data from one system to another, it is unlikely that this will persist indefinitely.   One has only to look around to see examples of technological advances which a decade or two ago seemed like science fiction, but are now reality.    Smart phones are one example.   Cars that park and drive themselves another.   There are thousands of examples of technological advances which the pessimists though could never happen which are now part of everyday life.

Interoperability between EMR products is not an unclimbable mountain, but neither is it a molehill.   It will be achieved, and it will happen in the not-too-distant future, but it requires effort, buy-in, and a can-do attitude.

Let’s make it happen.

I will be going to the NBMS Annual General Meeting again next year.  Next time I hope to be able to report, at day’s end, that more has been accomplished than fixing a light switch.